Alvi Abdul Rehman, Sheikh Ghulam Murtaza, Kazim Syed Faraz
Department of Surgery, Aga Khan University Hospital, Karachi.
J Pak Med Assoc. 2011 Oct;61(10):973-7.
To review the trends in management and analyze the factors influencing outcomes of acute necrotizing pancreatitis.
It was a retrospective analytical study. All adult patients with computed tomography with proven necrotizing pancreatitis managed at the department of surgery, Aga Khan University Hospital, Karachi were included in this study extending from January 1998 to January 2008. Outcome variables were hospital stay, complication rate and in-hospital mortality. Data analysis was carried out using SPSS version 16. For comparison, Pearson chi-square test, Fisher's exact test, t-test and ANOVA were used, where applicable. A p-value less than 0.05 was considered statistically significant.
Of 1479 patients, 47 patients were included. Median age was 48 (range: 38-56) years with 31 (66%) males and 16 (34%) females. Overall out of 18 (38%) that underwent necrosectomy, 16 had infected acute necrotizing pancreatitis while the rest were negative. Computed Tomography and/or FNAC identified 18 infective acute necrotizing pancreatitis patients, 16 underwent necrosectomy, one patient expired without surgery and the other was managed conservatively. Enteral nutrition was widely used with rising trend of oral feeding from 2006 onwards. Complication rate was 63%. Overall mortality remained 9/47 (19.7%), where in infected ANP as well as in postoperative patients, mortality was 7/18 (38.9%). The patients with early pancreatic necrosectomy had prolonged hospital stay, more complications and statistically significant increase in in-hospital mortality.
Better outcomes were achieved in infected acute necrotizing pancreatitis with delayed pancreatic necrosectomy and the other contributing factor could be early enteral nutritional therapy.
回顾急性坏死性胰腺炎的治疗趋势并分析影响其预后的因素。
这是一项回顾性分析研究。纳入1998年1月至2008年1月在卡拉奇阿迦汗大学医院外科接受计算机断层扫描确诊为坏死性胰腺炎的所有成年患者。观察指标包括住院时间、并发症发生率和院内死亡率。使用SPSS 16版进行数据分析。在适用的情况下，采用Pearson卡方检验、Fisher精确检验、t检验和方差分析。p值小于0.05被认为具有统计学意义。
1479例患者中，47例被纳入研究。中位年龄为48岁（范围：38 - 56岁），男性31例（66%），女性16例（34%）。在接受坏死组织清除术（占38%）的18例患者中，16例为感染性急性坏死性胰腺炎，其余为阴性。计算机断层扫描和/或细针穿刺活检确诊18例感染性急性坏死性胰腺炎患者，16例接受了坏死组织清除术，1例患者未手术死亡，另1例保守治疗。肠内营养被广泛使用，从2006年起经口喂养呈上升趋势。并发症发生率为63%。总体死亡率为9/47（19.7%），其中感染性急性坏死性胰腺炎患者及术后患者死亡率为７/18（38.9%）。早期行胰腺坏死组织清除术的患者住院时间延长，并发症更多，院内死亡率有统计学意义的显著增加。
感染性急性坏死性胰腺炎采用延迟胰腺坏死组织清除术可取得更好的预后，另一个促成因素可能是早期肠内营养治疗。
